Looking at the UN, smelling a rat

A comment
on ‘Sweden’s succesful drug policy: a review of the evidence’ UNODC
september 2006 [1]

The year
2009 will mark the centennial of the Shanghai Opium Conference, the first
world-wide agreement on the reduction of opium use and production. China, then
still an extremely poor feudal nation, was spending most of its foreign
exchange on opium it imported through British traders. The British sold their cheap
Indian Opium for pure silver to the Chinese, and had almost two centuries of
opium fortune-making behind them. The fledgling United States of America tried
to conquer a share of the profits in this lavish market, at a time when
prohibitionist ideas about alcohol and opium control were expanding all over
the globe. It was time for the American Disease to be born. [2]

In later
analyses of the history of drug and alcohol controls other names for the
American Disease have been coined. The most appropriate one, not tied to any
nationality per se, is the 'Temperance Movement'. It was comprised of a
collective of local movements prevalent in a group of nations. Later
these nine nations would be identified as a special group, the nations where
the temperance culture would endorse far reaching control policies in the
attempt to regulate medical and recreational drugs. [3] The global impact of these temperance cultures has varied from almost nothing
to considerable. It is this variance we will address in this comment because it
is at the heart of the report that will be discussed. Sweden represents the
most fundamentalist and extreme pole of this variance. Swedish policy makers
and popular ideologues developed their own logic , policy language and version
of Swedish drug history in order to convince themselves that no other policy
could be possible. [4]

The
UNODC in 2006

After
years of mismanagement, the UNODC not only has the difficult task of regaining
some status for itself. It also has the task of reinstalling faith into its
core business, the business of drug control. As its director aptly remarks in
the opening phrases of the report on Sweden : "More people experiment with
drugs and more people become regular users. There are thus suggestions, at the
European level, that drug policies have failed to contain a widespread
problem." (page 5)

The report
we will be discussing here has to be seen against the background of diminishing
support for present prohibitionist drug control policies world wide. It does
not have, according to me, a purely empirical nor scientific ambition. It is
too clumsy and too primitive for that to be the case. But as a helping hand is badly needed for
doubting drug control functionaries, struggling with the obvious increase in
drug use and drug production all over the world and the astounding inadequacy
of global policies, the report must be perceived as a genuine attempt to stand
behind them.

The report
about Sweden is "a rapid assessment, based on open-source documents,
supplemented by Government documents and information obtained from government
officials" (page 7) Why did UNODC choose Sweden as an example?

"..in the
case of Sweden, the clear association between a restrictive drug policy and low
levels of drug use, is striking."

"Swedish
drug policy is highly effective in preventing drug use."

"..a
review of fluctuations in abuse rates shows that periods of low drug abuse in
the country are associated with times when the drug problem was regarded as a
priority." (page7)

According
to this report, then, if ever you had doubts that drug control has effects on
levels of drug use, you should study the example of Sweden. Or, that if your
drug control is not working, nor effective enough, you will have problems with
drugs!

UNODC
director Costa said at the launch of World Drug Report 2006 that countries have
the drug problems they deserve. He repeats this remark in the Sweden report,
saying that "each government is responsible for the size of the drug problem
in its country. Societies often have the drug problem they deserve" (page 5)

So, we
have to see the present work of UNODC to be tailor made to arrive at the
conclusion that drug control works, and that a deficit in drug control will
translate into an increased 'drug problem'.

Let us see
how this precious work is done, and if it can stand the test of simple
questions asked about it.

I will
proceed by selecting just a few examples of how this is done, because if the
reader wants the full works, she had better read the full report. But since the
method behind the work is the same throughout, it does not matter much which
examples are chosen.

First, a
clear definition of the 'drug problem' is not supplied. It can be anything
UNODC deems it to be. Thus, the drug problem is defined as the level of drug
use in the population, or in certain age cohorts. This material is supported by
levels of 'heavy use' or drug abuse, a category that is not defined either.
Drug use and drug abuse are freely interchanged in the language of the report,
thereby repeating a source of confusion that has become standard in most
writing about 'the drug problem'.

The first
problem clearly is with the data that are chosen. I do not mean the reliability
of the data, for that is a huge problem on its own (not discussed in the
report). I mean that the choice of data that are presented for supporting the
case of Sweden's success, is left to the authors. Since there is no clear
theory about what data are needed to create a standard description of the drug
situation in a country, we can not blame UNODC for this. They simply use the
lack of scientific or standardised clarity to legitimise their agenda. [5]

So, by
showing many tables of use of (cannabis) drugs, mostly with 15 year old school
children or of 18 year old army conscripts, they define drug use levels in
Sweden. In a few other places prevalence data are given for the Swedish
population between 15 and 75 years old. All these data are then compared,
sometimes to other individual countries, but most frequently to the European
average, as reported by EMCDDA in Lisbon. The Sweden report then shows that
on most of these variables Sweden shows scores below EU average.

However,
if one studies the tables that EMCDA provides for drug use, such as the last
year use of cannabis for the drug use age cohort of 15-34 year olds, one can
not escape the fact that 14 countries out of 19 produce prevalence figures
below the EU average [6]. So in
theory it would be possible to produce a UNODC report with the title "The
successful drug policy of the Netherlands," because on many indicators of drug
and alcohol use and of the number of 'heavy users' seen in treatment, the
Netherlands produces indicators that are (well) below the European average, and
far below the USA or Australia. Just like Sweden.

In the
same vein UNODC could produce a series of reports called "The catastrophic drug
policy of" France, the UK, or the Czech Republic, or the USA because these UN
members show indicators of (some) drug use that are higher or far higher than
the EU average.

We invite
UNODC to write such reports, as soon as possible!

Sweden is
also lauded because of the vast resources it spends on drug use prevention and
drug policy in general. But Greece, (a culture profoundly different from those
of the Netherlands or Sweden) spending almost nothing, the least of all EU
countries on drug policies, has even LOWER drug use figures than Sweden (if one
chooses to believe the Greek data).

Looking at
other figures from Sweden, ones that are not mentioned in the UNODC report, one
sees that Sweden has relatively low levels of alcohol use, and low levels of
tobacco use. (Liters of consumed pure alcohol per year in Sweden is 7, versus
10 in Holland and Greece, 14 in France. The percentage of daily smokers in
Sweden is 16, versus 30 in the Netherlands and almost 40 in Greece) And the
Swedes use relatively few pharmaceutical drugs as well, spending on them less
than most countries in the EU (7% of health expenditures - the only country
spending less than that is Norway, with 6%. The Dutch spend 12%!! The champion
pharma client is Spain, with 23%) [7]

So, in
order not to fall into the trap of a detailed discussion of the hand picked
data used in the UNODC report on Sweden, I would like to stress that the basic
assumption of that report does not have any scientific legitimacy. The basic
assumption is that the low figures that Sweden shows on a series of indicators
on recreational drug use are due to Sweden's drug policy. Maybe! And let us for
the convenience of the argument ignore the quality of the data. But to propose
this association, as the UNODC report clearly does, it should at least show
some evidence the two are causally related, and why. This evidence is so
completely lacking that one may ask if the report should not be seen as a
religious document that is intended to prop up faith in drug control rather
than an attempt at scientific rigour and clarification.

The
other thesis: drug control is irrelevant for levels of drug use.

Maybe
Sweden's drug policy is just another phenomenon on its own, next to low levels
of alcohol and drug use, that EXPRESSES a temperance culture, but does not
cause it. In other words, even if Swedes were to choose a less extreme policy,
their temperance culture would still produce low levels of intoxicant use,
lower than some but not all countries.

The
Greeks, using little alcohol and drugs as well, will produce their own
low figures from a series of completely different cultural or demographic
characteristics and determinants, as do the Dutch.

Nothing
contradicts the thesis that drug policies, whatever they may be, have little to
do with the production of the drug and alcohol situation that is found. For
UNODC to even contemplate this 'cultural construction' notion would be
disaster, because it opens the road to a scientific analysis of drug
situations, separating it from the ideological analysis that suits UNODC. And
this notion would completely invalidate Mr. Costa's conviction that countries
have the drug problem they 'deserve' if they fail in drug control orthodoxy.

Another
way of looking at the situation would be to correlate demographic and cultural
variables to a local drug situation. For instance, in the Netherlands
epidemiological research has shown that levels of cannabis use in the densely
populated urban regions of the country is almost four times as high as in the
open spaces of the rural regions. In other words, within a nation with a
highly homogeneous drug policy, differences in use levels can be higher
than between nations with markedly different drug policies. Also, in
Amsterdam life time prevalence of cannabis use is about twice as high as in
Rotterdam in spite of the identical drug policies reigning. [8] In the Netherlands the growth of the urban population has been high from 1975
until 2005, with levels varying from 0,5% to over 1% per year. In Sweden during
this period urban growth has been less than 0,1 % per year (with the exception
of the period 1990-1995, with 0,17% urban growth, exactly when drug use
experienced an increase in Sweden) [9]

It would be
relevant to develop a line of reasoning in which proportions of urban/rural
populations, and the change thereof, could be seen as a demographic variable
that influences levels of drug use and the emergence of drug use fashions,
irrespective of the drug 'policies' that are undertaken.

Another
demographic variable might be the proportion of the elderly in the population.

In Greece
- where cannabis use is lowest of all Europe - 44% of the population (compared
to work force) are aged 65 or older. In Sweden, with 33% of the population
older than 65, we observe slightly higher cannabis use. Slightly higher still
cannabis use in the Netherlands corresponds with 24% of the population older
than 65 (compared to work force)! But such simple eye catching associations
will not create serious possibilities for understanding variation of drug use
level in the populations of the world. Combinations with other variables will
have to be developed. Important aspects of working life may be candidate
variables. In Greece, with a relatively old population and a relatively high
rate of unemployment (10% in 2004), people have to work a lot of hours for
their income (1925 hours per year). Compare this with the Netherlands, with a
relatively young population and low unemployment rate (4,6% in 2004): people
work a far shorter time for their income (1357 hours). Couple this to
continuous increases of urbanization and urban life styles in the Netherlands
and we have a background for recreational behaviour that is different, perhaps far
different, than other countries may exhibit. Countless local variations in
these variables may exist as well, presenting nearly ideal conditions to test
theories using these combinations of variables in relation to well measured
(standardized!!) prevalence data and their development over time.

The
possibility of examining reasonable hypotheses that relate drug use levels
with combinations of economic, demographic or cultural variables has, however,
not even begun to be explored. Rather, the dominance of ideological analysis is striking. But
such studies would clearly help answer questions about why levels of drug use
vary so vastly within Europe, and within countries. [10]

Drug
policy costs, are there any?

The UNODC
report on Sweden is not completely silent on the costs of Swedish drug control
but gives them relatively little place. It mentions the funding it requires,
and it mentions the high proportion of heavy (and severely marginalised) drug
users who are subject to coerced and non-coerced treatment. It also shows that
the proportion of high intensity/high frequency drug users is not markedly
different in Sweden than in most other EU countries! The report also mentions
the large number of drug deaths that is part of the Swedish drug situation but
notes that it decreased "from 403 cases in 2001 to 385 cases in 2003" (page 33)
to underscore the positive tone about the Swedish drug control. Unfortunately
the topic of drug related deaths is not further elaborated, which led Ted
Goldberg to note the following:

"The figures UNODC uses for drug related deaths are
misleading. Peter Krantz, a postmortem examiner, has been studying statistics
for drug related deaths as revealed in autopsies. He found 296 in 2000 and 425
in 2002. To give you an idea how high 425 is in a country the size of Sweden,
it means 1.2 per day in a country where 1.5 per day die in traffic accidents.
And of course it's not recreational consumers who are dying. Contemporary drug
policy is in fact an important reason why so many problematic consumers die.
Drug policy accomplishes this by driving users further out of society, by
coercing them into meaningless and repressive treatment, by making them afraid
to contact the authorities when, for instance someone has overdosed, by not
providing injection facilities where people don't have to be in a hurry and can
take a part of an injection and wait and see what happens so they don't
overdose, and where there is qualified help on the premises, etc.

Drug policy as it is today is actually killing people - not
saving lives." [11]

The topic
of drug related deaths is treated in the UNODC report without comparing the
Swedish rate to DRD rates in other countries (in dark contrast to the overdose
of such comparisons of drug use in 15 year olds). We know that the variable
'drug related death' is not the gold standard of precision and that in spite of
feeble EMCDDA efforts serious unsolved registration, definition and
calculation issues are at stake here, as much as with all other
non-standardised variables in the epidemiology of the drug arena. But if we
trust the bookkeeping talents of EMCDDA we have at least some insight into the
drug deaths data each government supplies to the international shareholders of
the drug problem industry.

EMCDDA
reports a lower number of drug related deaths (DRD) than UNODC for the year in
which comparisons are calculated, 2002 or thereabout. It reports that Sweden
has 160 DRD in 2002 and the same proportion of DRD as Greece, 18 per million
inhabitants (versus 7 for the Netherlands or 55 for the UK). UNODC, Goldberg,
but also Lenke and Olson mention a much higher number than EMCDDA because they
include other types of DRD than overdose only. UNODC mentions 391 for 2002,
Goldberg mentions 425 for 2002 , Lenke and Olson [12] mention 350 for 1999. Accepting these numbers would considerably raise the
present computations by EMCDDA of the DRD rate per million inhabitants in
Sweden. It would topple that country from a relatively middle position versus
other countries to a high position.

A dramatic
issue that is not dealt with at all in the report is the far reaching power of
the special drug police. In Stockholm, police will chase drug users all through
the night and collect them in their vans from the streets, and from the cafés.
Trained special police can go into a bar, merely look one in the eye and arrest
him or her, then drag them into police headquarters where blood is extracted
from them against their will. Police violence on the drug using population is
carefully nurtured in Sweden as a necessary element in the witch hunt against
this alien evil, drugs.

In an
emotional appeal to the audience , the chairperson of the newly created Swedish
Drug users Association asked in 2003 in Lisbon for a reform of Swedish drug
policy because of the hardships it creates for all users, especially so called
'heavy' users. He asked for the creation of needle exchange and expansion of
the availability of methadone for which there are far too few treatment
opportunities. [13]

Stahlenkrantz
also mentions that heavy users "sometimes avoid calling for an ambulance
because they are too scared of attracting the attention of social workers or
the police." (see ref 9).

Discussion

Harry
Levine writes that Sweden uses far less alcohol than other countries "but they
worry about it far more than almost anybody except other nordics and some
English speaking countries" (personal communication), thereby illustrating his
well known observation about the special character of the Protestant temperance
cultures in relation to the use of alcohol and drugs.

The same
scholar writes in a personal communication:

It is important to understand that shock waves
have recently rolled over the Nordic alcohol model, forcing the Nordic
societies to radically reconsider a hundred years of temperance-oriented
alcohol policies. A group of Finnish and other drug researchers have written a
smart, interesting book about this with the telling title: Broken Spirits.
Power and Ideas in Nordic Alcohol Control.

Stanton
Peele writes about the temperance countries in his review of Broken Spirits: "Broken
Spirits describes the post-World War I creation of state alcohol monopolies
in the Nordic countries, including Iceland, as 'a spectacular historical
experiment in social control.'" [14]

The word
'spectacular' is fully applicable to the type of drug prohibition in these
countries as well, being subordinated to the same control fundamentalism as has
been shown toward alcohol, but in a higher gear, and of meaner disposition.

These
remarks by Levine and Peele invite us to think that the perceived decay of
alcohol control policies in Sweden, as well as in other Nordic countries may be
behind some of the brute tenacity that is shown in relation to conserving drug
policies [15]. It
is such tenacity that UNODC wants to see applauded, and we fear that UNODC will
use the year 2009 to promote China to the status of hero of drug control, in
spite of the disasters drug control is creating in relation to Chinese human
rights (even more than in Sweden or the USA). We may not be surprised when
UNODC presents us with a report that drug control in China is excellent,
successful and that the number of public executions of drug sellers is actually
declining from 1909 a year to 1896!

[5] Until now we do not have for drugs what we do have for the economy, a
standardised profile of economic indicators as provided by the World Bank or by
OECD. Also the economic indicators themselves have been standardised. For
instance, OECD provides comparison between 'standardised' calculations of a
nation's unemployment in order to circumvent the large variety of data that
individual governments supply of 'unemployment'. By dedicating institutions to
the production of methodologically homogenised indicators , comparisons become
possible. EMCDDA in Lisbon was assumed to supply this for drugs but has not the
funding nor the management to do this. Maybe drug situation profiles should be
produced by OECD, steeped into the difficulty of indicator driven profile
production as they are. For pharmaceutical products and production OECD does a
great job already.

[10] Political resistance against such notions can be understood as resistance to
loosing a wonderful tool for political fire works.Drug policy is a tool that,
lacking in definition or clarity, maybe used for all sorts of rallying the
troops behind moral entrepreneurs who 'will defend youth against drugs' while
sending them into wars or imprisoning them in their urban getto's.

[13] Berne Stahlenkranz,Stockholm: " The tragic outcome of Sweden's dream of a good
drug free Society" Lisbon 2003 Senlis Council. Stahlenkranz speaks of the
'extreme measures' in Sweden from a point of view that is never mentioned in
reviews of Swedens policy, the perspective of the drug user. I recommend
organisers of conferences to invite him and ask for some of his descriptions of
the police activity in Stockholm.

[15] Goldberg sees signs that the drug policies may show some relaxation, as the
alcohol policies, and that voices pleading for expansion of needle exchange and
methadone prescription are now gaining influence in Sweden (personal
commincation).

[i] Thanking Peter Webster for his editing, and clarifying where badly needed.